Transcript Patient Instructions

GONIOMETRY
MEDICAL REHABILITATION OF 6TH HOSPITAL
AFFILIATED JIAOTONG UNIVERSITY , SHANGHAI
YUE--HONG BAI
 Introduction to goniometry
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Goniometry is the measuring of angles created by the bones of the
body at the joints. These joints are measured by a goniometer. The
goniometer has a moving arm, stationary arm, and the fulcrum. The
fulcrum or body is placed over the joint being measured and on it is a
scale from 0 to 180. The stationary arm will be aligned with the
inactive part of the joint measured, while the moving arm is placed
on the part of the limb which is moved in the joint’s motion. For
example, when measuring knee flexion, the stationary arm will be
aligned over the thigh in line with the greater trochanter of the femur.
The fulcrum is aligned over the knee joint or lateral epicondyle of the
femur, and the moving arm with the midline of the leg or lateral
malleolus.

Performing these tests is important for many reasons. First, the
mobility of joints is important for diagnosis and determining the
presence or absence of dysfunction. In a chronic condition,
goniometry can measure the progression of the disorder. An example
of this is the progression of rheumatoid arthritis. Furthermore, joint
motion measurement can evaluate improvements or lack of
progression during rehabilitation. This not only provides motivation
for the patient when there are improvements, but also can decipher if
modifications need to be made if treatment is not effective.
LOGO
ANKLE GONIOMETRY
LOGO
Dorsiflexion
Patient Instructions
 Ask the patient to bend the ankle and point their toes
up towards the ceiling
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Starting Position:
· Patient is sitting with legs off the table.
· The fulcrum is aligned with the lateral malleolus.
The stationary arm is in line with the midline of the
lower leg; use the head of the fibula for reference. The
moving arm is parallel to the fifth metatarsal.
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Note

Once again remember that the goniometer will be at
90 degrees and to adjust for that when recording the
angles.
 Ending Position:
 · Same as above
 Normal ROM for dorsiflexion is between 20 and 30
degrees. The patient has 3 degrees of dorsiflexion.
LOGO
Plantarflexion
Patient Instructions:
Ask the patient to point their foot down toward the
ground.
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Starting Position and Ending Position:
· Patient is sitting with legs off table.
· Goniometer alignment is the same as for dorsiflexion.
Normal ROM is 30 to 45 degrees, the patient is at 27
degrees.
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Inversion at the Tarsal joints
 Patient Instructions:

Have the patient turn their foot in.
 Starting and Ending Position:
 ·
Patient sitting with legs off the table, or patient
can be supine on the table with the foot resting on the
table.
 ·
The fulcrum is positioned between the two
malleoli. The stationary arm with the midline of the
tibia and the moving arm with the second metatarsal.
 Normal ROM is 35 to 45 degrees; patient has 40
degrees of inversion.
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LOGO
Eversion at the Tarsal joints
 Patient Instructions:

Ask the patient to turn their foot out.
 Starting and Ending Position:
 ·
Patient sitting with legs off the table, or patient
can be supine on the table with the foot resting on the
table.
 ·
The fulcrum is positioned between the two
malleoli. The stationary arm with the midline of the
tibia and the moving arm with the second metatarsal.
 Normal ROM is 15 to 25 degrees; patient is in 30
degrees of eversion
LOGO
Inversion at the Subtalar joint
 Patient Instructions:

Ask the patient to turn their foot in.
 Starting and Ending Position:
 · The patient should be lying prone with foot hanging
off the table.
 ·
The fulcrum is placed between the two malleoli.
The stationary arm is aligned with the midline of the
leg and the moving arm with the midline of the
calcaneus.
 Normal ROM is 5 to 20 degrees, the patient is in 20
degrees of inversion
LOGO
Eversion at the Subtalar joint
 Patient Instructions:

Ask the patient to turn their foot out.
 Starting and Ending Position:
 · The patient should be lying prone with foot hanging
off the table.
 · The fulcrum is placed between the two malleoli.
The stationary arm is aligned with the midline of the
leg and the moving arm with the midline of the
calcaneus.
 Normal ROM is 5 to 15 degrees, the patient is in 15
degrees of eversion
LOGO

Knee Goniometry
LOGO
Flexion
 Patient Instructions:
 Ask the patient to bend their knee as far as they can.
If the patient is able, he/she should also flex at the
hip to get complete knee flexion. If the patient cannot
flex at the hip this measurement can also be done in
the prone position.
 Starting PositionPatient should be supine with both
legs flat on the table.
 · The fulcrum is aligned with the lateral epicondyle of
the femur.
 · The stationary arm is in line with the greater
trochanter and midline of the femur, the moving arm
with the lateral malleolus and midline of the fibula.
LOGO
Ending Position:
 Goniometer positioning is same as above.
 Normal ROM is 135-150 degrees, the patient in the
picture is in 146 degrees of knee flexion
LOGO
Extension
 Patient Instructions:
 The patient should simply be lying prone with a towel
placed underneath the thigh or foot off the end of the
table, to gain full knee extension.
 Starting and Ending Position:
 · The patient should be lying prone with both legs flat
on the table.
 · The goniometer positioning for knee extension is
the same as it is for knee flexion.
 Normal ROM for knee extension is between 0 and –10
degrees. The patient has –3 degrees of knee
extension.
LOGO
Hip Goniometry
LOGO
Flexion
 Patient Instructions:
 Ask the patient to bend their knee and bend their leg and
bring it as close to their chest as is comfortable for them.
 Starting and Ending Position:
 · The patient should be lying supine in the anatomical
position.
 ·
The fulcrum is aligned with the greater trochanter of
the femur.
 · The stationary arm is positioned along the lateral
midline of the abdomen, using the pelvis for reference,
the moving arm along the lateral midline of the femur.
 Normal ROM is between 115 and 125 degrees. The
patient is in 115 degrees of knee flexion
LOGO
LOGO
Extension
 Patient Instructions:

Have the patient lift their leg off the table as far as
they can.
 Starting and Ending Position:
 · Patient is lying prone with legs together and arms at
sides.
 · Goniometer positioning is the same as for hip flexion.
 Normal ROM for hip extension is 10 to 30 degrees,
patient has 25 degrees of hip extension.
LOGO
Abduction
 Patient Instructions:

The patient should be asked to move their leg out
to the side as far as they can.
 Starting Position:
 · Patient is supine in anatomical position.
 · Fulcrum is placed in line with the anterior superior
iliac spine.
 · The moving arm of the goniometer is aligned with
the midline of the patella, the stationary arm with the
ASIS of the opposite side.
 · Note: This places the goniometer reading at 90
degrees, to determine the actual reading make sure to
read 90 as 0 and determine the measurement in that
manner.
LOGO
 Ending Position:
 · Same as above
 Normal ROM for hip abduction is 40 to 50 degrees; the
patient has 48 degrees of hip abduction.
LOGO
Adduction
 Patient Instructions:
 Ask the patient to move their leg to the inside toward their
opposite leg.
 Starting Position:
 · Patient is supine the leg not being measured is abducted
to allow full adduction of the opposite leg.
 · The goniometer positioning is the same as for abduction,
fulcrum at the ASIS, moving arm aligned with the midline of
the patella, and the stationary arm with the ASIS of the
opposite side. Also, remember to adjust due to the
goniometer starting at a reading of 90 degrees.
 Ending Position:
 · Same as above
 The normal ROM is 15 to 25 degrees. The patient has 18
degrees of hip adduction.
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LOGO
Medial (Internal) Rotation
 Patient Instructions:
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Have the patient bring their leg out to the side.
 Starting Position:
 ·
The patient will be sitting off of the edge of the
table, knees against the table, with their legs dangling
down off the table.
 ·
The fulcrum is aligned with the patella and both
arms of the goniometer with the midline of the tibia.
 Ending Position:
 ·
The fulcrum and moving arm remain in the same
position as above.
 ·
The stationary arm should now be hanging freely
but should be perpendicular to the floor.
 The normal ROM for internal rotation is 35 to 50
degrees. Patient has 49 degrees of internal rotation at
the hip.
LOGO
Lateral (External) Rotation
 Patient Instructions:
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Ask the patient to move their leg in toward the opposite
leg.
 Starting Position:
 ·
Patient is sitting on the edge of the table as was done
for internal rotation. The leg not being measured can either
remain off the table or can be on the table depending on the
ability of the patient. The patient in the picture has her leg
on the table to her side.
 ·
The goniometer positioning is the same as for lateral
rotation. The fulcrum is aligned with the patella, and both
arms with the midline of the tibia.
 Ending Position:
 ·
The fulcrum and moving arm are still in the same
position.
 ·
The stationary arm should be hanging freely and
perpendicular to the floor.
 Normal ROM is between 25 to 40 degrees, the patient in the
picture is at 26 degrees.
LOGO
LOGO
 Shoulder Goniometry
LOGO
Flexion
 Patient Instructions:
 Once the goniometer is aligned properly ask the
patient to lift the arm up just as if they were raising
their hand to ask a question. Be sure that the patient
keeps the palm of their hand facing in toward their
body.
 Starting Position:
 ·
Patient is supine with arm at side and the palm
of the hand facing the body.
 ·
The fulcrum of the goniometer is placed over the
acromion process.
 ·
The stationary and moving arms are aligned with
the midline of the humerus and lateral epicondyle
LOGO
 Ending Position:
 · The moving arm remains in line with the lateral
epicondyle and midline of the humerus. The examiner
should be supporting the patient’s extremity.
 · The stationary arm should remain in its starting
position, only now it should be in line with the lateral
midline of the thorax.
 Normal ROM for glenohumeral flexion is 160 to 180
degrees; in the picture the patient is in 180 degrees of
flexion.
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LOGO
Extension
 Patient Instructions:

Ask the patient to simply lift their arm off the table
as far as they can.
 Starting Position:
 ·
Patient is prone with arm at side; make sure the
head is facing away from the shoulder being tested.
Elbow should be bent slightly and the palm facing in
toward the body.
 ·
The fulcrum is placed over the acromion process.
 ·
The stationary and moving arms are aligned with
the lateral midline of the humerus and the lateral
epicondyle.
LOGO
 Ending Position:
 ·
The moving arm remains in line with the lateral
epicondyle and the examiner should support the
patient’s extremity.
 ·
The stationary arm should be in line with the
midline of the thorax.
 Normal ROM for glenohumeral extension is 40 to 60
degrees; in the picture the patient is in 61 degrees of
extension.
LOGO
Abduction
 Patient Instructions:
 Have the patient bring their arm out to their side and as close
to their head as they can. Make sure that their palm faces
upward throughout the motion.
 Starting Position:
 · The patient is supine with arm at side; the palm should be
facing anteriorly.
 · The fulcrum is placed at the acromion process.
 · The stationary and moving arms are aligned with the
anterior midline of the humerus.
 Ending Position:
 The stationary arm should remain still and parallel to the
sternum.
 · The moving arm should still be resting at the anterior
midline of the humerus.
 Normal ROM should be between 160 and 180 degrees; the
patient in the picture is in 174 degrees of abduction.
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LOGO
Medial (Internal) Rotation
 Patient Instructions:

Ask the patient to rotate their arm down as far as
they can.
 Starting Position:
 · Supine with 90 degrees of shoulder abduction and the
elbow is in 90 degrees of flexion. The table should not
support the elbow.
 · The fulcrum should be centered over the olecranon
process.
 · The moving arm is aligned with the ulnar styloid and
the stationary arm should be perpendicular to the floor.
 Ending Position:
 · Same as above
 Normal ROM is 60-70 degrees; the patient is in 68
degrees of internal rotation
LOGO
Lateral (External) Rotation
 Patient Instructions:

Ask the patient to rotate their arm up toward their head
as far as they can.
 Starting Position:
 ·
Supine with 90 degrees of shoulder abduction and 90
degrees of elbow flexion. The table should not support the
elbow. (Refer to above picture)
 ·
Fulcrum should be on the olecranon process.
 ·
The moving arm should be aligned with the ulnar
styloid and the stationary arm should be perpendicular to
the floor.
 Ending Position:
 ·
Same as above
 Normal ROM is between 80-100 degrees; the patient in the
picture is in 93 degrees of external rotation.
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LOGO
Elbow Goniometry
LOGO
Flexion
 Patient Instructions:
 Ask the patient to bend their elbow as far as they can,
try and touch their shoulder.
 Starting Position:
 ·
Supine, arm should be in the anatomical position.
It will be easier to align the goniometer if the arm of
the patient is resting on the edge of the table.
 ·
The fulcrum should be aligned with the lateral
epicondyle of the humerus.
 ·
The stationary arm is positioned along the
midline of the humerus, the moving arm is aligned
with the radial styloid process.
LOGO
 Ending Position:
 · The arm is now flexed at the elbow, the goniometer
should still be aligned with the correct anatomical
landmarks as described below.
 Normal ROM is between 150-160 degrees, the patient
has 155 degrees of elbow flexion.
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LOGO
Pronation
 Patient Instructions:

Have the patient turn their wrist down toward the
ground.
 Starting Position:
 ·
Patient sitting up with elbow bent 90 degrees and at
patient’s side, wrist in a handshake position.
 ·
The fulcrum is placed just behind the ulnar styloid
process.
 ·
The moving arm and stationary arm are parallel with
the anterior midline of the humerus.
 Ending Position:
 ·
The fulcrum should remain in the same position as
above.
 ·
The stationary arm will still be aligned parallel to the
midline of the humerus, the moving arm will lie across the
dorsum of the forearm just behind the ulnar and radial
styloid processes
LOGO
LOGO
Supination
 Patient Instructions:
 Have the patient turn their palm up as if they are
holding something in the palm of their hand.
 Starting Position:
 · Patient position is the same as for pronation.
 · The goniometer is placed on the medial aspect of the
forearm with the fulcrum at the radioulnar joint.
 · The arms are both aligned with the anterior midline
of the humerus.
 Ending Position:
 · The moving arm will be resting on the medial
forearm at the radioulnar joint. The moving arm
should remain parallel to the midline of the humerus.
 Normal ROM is 81-93 degrees, the patient has 90
degrees of supination.
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LOGO
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